Evaluation report : malaria control project/Ecuador (project number 518-0049)

Mid-term external evaluation covers the period 3/85-5/87 and is based on document review and interviews with USAID/DR and SNEM personnel. The project faces a variety of administrative problems: (1) the failure of the contractor, United Schools of America, to meet performance expectations; (2) the reluctance of the Ministry of Health to purchase DDT, although it is considered efficacious for many malarial situations in Ecuador; (3) continuing problems in labor relations; and (4) lack of management training in the past. However, the efficiency of the SNEM Directorate and the commitment and experience of the long-term advisor compensate for many of these difficulties, and training of mid-level administrators is scheduled for the near future. A variety of operations research studies have been undertaken, many with the help of external TA. Topics include a computerized malaria information system; the sensitivity of Plasmodium falciparum to drugs; Anopheles vector incrimination; urban mosquito control; an urban anopheline evaluation system; insecticide resistance; and Aedes aegypti breeding and larval density. Studies on other vector-borne diseases have also been conducted, along with a series of KAP studies. Actions to upgrade malaria surveillance and control have included strengthening of the malaria case detection system (which relies on passive detection by voluntary collaborators and the General Health Services; decentralization of malaria diagnosis/treatment through the location of microscopy laboratories in peripheral areas; staff training in entomological surveillance; revision of the information system; and stratification of malarious areas. The project is also expected to greatly enhance institutional capacity in the SNEM and related agencies through study tours and long- and short-term training. On the other hand, little progress has been made in health education, except in urban areas, where workshops and seminars have been held to enlist the active support of various schools and other institutions. Appropriate TA for health education materials development and evaluation, mass media campaigns, and community participation strategies is currently being identified. Recommendations are made for each of the above-noted project areas.